Page 722 - Problem-Based Feline Medicine

714 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

Hemogram and serum biochemistry profile findings Motility-modifying agents, such as metoclopramide,
will likely be normal if the condition is acute. should not be used until the obstruction is relieved.
Long-standing or severe linear foreign bodies or GI
perforation will show an inflammatory response, IDIOPATHIC INFLAMMATORY BOWEL
evidence of dehydration (hemoconcentration or ele- DISEASE (IBD) (LYMPHOPLASMACYTIC
vated proteins) and electrolyte abnormalities consis- ENTERITIS, EOSINOPHILIC
tent with vomiting (hypokalemia is most common). ENTEROCOLITIS)
The diagnosis is obtained by imaging studies, includ-
Classical signs
ing radiography (plain or contrast studies looking for
evidence of an obstructive gas pattern), ultrasonogra- ● Vomiting, anorexia and weight loss are the
phy or upper GI endoscopy. In some cases, endoscopy most common signs of upper GI IBD.
will allow retrieval of the foreign object, and is a useful ● Diarrhea can occur.
means of assessing other damage (e.g. erosions, ulcers, ● Affected cats are usually middle aged or
or tears in the mucosa). older, with no particular sex or breed
predisposition.
Differential diagnosis
See main reference on page 768 for details.
Acute diarrhea is not the classic clinical sign of
a foreign body, but may occur in combination with
Clinical signs
vomiting or anorexia, and can occur without these
signs if the obstruction is more distal. Typically, IBD is associated with upper GI signs
of chronic intermittent vomiting, weight loss and
Some cats with linear foreign bodies have a wax-
anorexia.
ing\waning course of vomiting, diarrhea or anorexia
that may not suggest the diagnosis immediately. Diarrhea is also observed in some cats, when the dis-
ease affects the colon or distal small intestine. This
Other differentials in those cases would include infec-
occurs less often in cats than in dogs. Acute exacerba-
tious, dietary or inflammatory gastrointestinal diseases.
tion of diarrhea may occur.
Most cats with IBD have chronic signs of GI disease.
Treatment
The disease is most prevalent in middle-aged to older
In cases where the object is still in the stomach, it is cats, but the range is from 6 months to 17 years.
sometimes possible to safely retrieve the object (nee-
There appears to be no breed or sex predisposition to
dle, small toy, etc.) via an endoscopic procedure.
IBD in most studies, but purebred cats and males
Most GI foreign bodies however, will require surgical appear to be over-represented in some studies.
removal, and some may be a surgical emergency
when GI perforation has occurred.
Diagnosis
Cats that are severely dehydrated from persistent
IBD is a diagnosis of exclusion, that requires two
vomiting, or have suspected intestinal perforation
steps: (1) the histopathologic confirmation of an
and leakage should be stabilized as much as possible
excessive inflammatory response, and (2) the elimina-
with aggressive fluid therapy and broad-spectrum
tion of the multitude of potential causes for GI
antibiotics prior to surgery (e.g. combination of ampi-
inflammation.
cillin/amoxicillin or cefazolin and enrofloxacin,
amikacin or cefoxitin). Some cats with a protracted his- The majority of cats with IBD will have a normal
tory of vomiting will benefit from histamine-2 block- hemogram and serum chemistry profile, however,
ers or GI protectants if gastritis or gastric erosions are afew abnormalities are not uncommon, but they are
suspected. not specific for IBD. These include leukocytosis, mild